Accessing Medical Care as a Foreigner in the United States
The United States is home to some of the world’s most advanced medical technology and quality healthcare services. However, for foreigners, whether visiting briefly or living long-term, the U.S. healthcare system can be complex, confusing, and costly to navigate.
Unlike many countries with universal healthcare, the U.S. relies heavily on a mix of private insurance, government programs, and out-of-pocket payments. Without a clear understanding of typical costs and options, it’s easy to encounter unexpected bills or barriers to care.
This article explains how healthcare works in the U.S., breaking down key costs and practical tips to help foreigners confidently access medical care during their stay.
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How Does the U.S. Healthcare System Work?
The U.S. healthcare system is a vast and complex network of both public and private providers, including nonprofit and for-profit hospitals, clinics, specialty centers, university medical centers, and independent practices.
While many facilities are privately owned, some are government-run, and funding comes from a combination of public programs, private insurance, and direct payments by patients.
Unlike many developed countries, the U.S. does not provide universal free healthcare. Instead, most medical services require out-of-pocket payments or insurance coverage.
While some cities and states offer free or low-cost clinics, access is limited and varies significantly across the country.
As a result, most Americans rely primarily on health insurance to cover medical expenses, often supplementing with out-of-pocket costs.
Read More: Countries With Free Healthcare
Federal and State Roles in Healthcare
Both federal and state governments shape healthcare policy in the U.S. The federal government sets nationwide standards and regulations, while states have significant control over local healthcare implementation.
This results in wide variation in access and policies across states. For example, Massachusetts has strong healthcare policies and funding aimed at expanding coverage and reducing the number of uninsured residents.
As of January 2025, the federal government has been restructuring national health agencies and introducing new regulations to improve the system.
Public Healthcare Programs and Eligibility
Public healthcare support is available at the federal level for specific groups, including veterans, seniors aged 65 and over, and people with disabilities.
Medicaid also covers certain populations, including children, pregnant women, and low-income individuals, but eligibility and benefits vary by state. Enrollment is not automatic; applicants must apply and prove their citizenship or legal residency.
The Affordable Care Act (ACA), enacted in 2010, also expanded access to health insurance and established a government-run marketplace for individuals to purchase coverage.
Private Healthcare in the U.S
The U.S. healthcare system is primarily private, with most hospitals and medical practices owned privately.
According to the U.S. Census, over 65% of Americans rely on private coverage to access a combination of private and public healthcare services.
Private facilities often offer specialized care and amenities beyond those available in public settings.
Services and Access in Private Healthcare
Private healthcare services range widely, from basic checkups to concierge-level care. Having a primary care provider (PCP) is important for preventive care and coordinating specialist visits, especially for families.
Patients frequently use online reviews to choose providers, and many healthcare professionals in the U.S. are internationally trained, making it easier for expats in large cities to find doctors who speak their language.
While waiting times to see specialists exist, they are generally less than 30 days. Federal regulations require insurers to approve urgent care within 72 hours and standard care within seven days.
Funding and Costs in Private Healthcare
Private healthcare is mainly funded through health insurance premiums paid by employers and individuals, supplemented by out-of-pocket expenses, especially for elective or non-emergency care.
Most hospitals operate as privately owned nonprofits, though some are government-run or for-profit.
Federal and state regulations influence healthcare costs in the private sector. However, pricing and billing can vary widely between providers, making it essential for patients to understand their coverage and costs in advance.
How Good Is U.S. Healthcare?
The U.S. healthcare system offers some of the most advanced medical services in the world, particularly in complex and specialized fields.
Each year, between 100,000 and 200,000 international patients travel to the United States for treatments that may be unavailable or less accessible in their home countries, highlighting the country’s cutting-edge medical capabilities.
The 2024 U.S. News & World Report ranked the United States 19th globally for well-developed public health systems, placing it within the top 25 worldwide and ahead of several European countries struggling with overburdened healthcare systems.
Nearly 20% of the world’s best hospitals are located in the U.S., including prestigious institutions linked to major universities, such as Johns Hopkins Hospital in Baltimore and Stanford Health Care in California.
However, this level of care comes at a significant cost. The U.S. spends more per capita on healthcare than any other developed nation and allocates a larger share of its GDP to health services than most wealthy countries. For patients without comprehensive insurance, costs can be especially high.
The Pros and Cons of U.S. Healthcare
Below is an overview of the main advantages and drawbacks of the U.S. healthcare system.
The Pros of U.S. Healthcare
Despite the high costs, patients benefit from several key advantages, including:
- Choice of Care: With health insurance, patients can usually choose their primary care doctor within their insurer’s network, allowing for personalized care that fits individual needs.
- High-Level Care: The U.S. is home to world-renowned healthcare facilities such as the Mayo Clinic and the Cleveland Clinic, which are known for their excellent care and advanced treatments.
- State-of-the-Art Treatment: The country also boasts some of the world’s top hospitals specializing in cancer, cardiovascular disease, and brain surgery. These facilities utilize the latest technology to treat complex and severe conditions effectively.
- Wide Range of Facilities: Major cities offer many healthcare options, including public and private hospitals, surgery centers, urgent care clinics, and specialty clinics, ensuring patients can find the care they need.
- Telehealth Infrastructure: The rise of telehealth services means that patients can consult doctors remotely, making it easier to access medical advice and care without traveling.
The Cons of U.S. Healthcare
Despite its many strengths, the U.S. healthcare system also faces significant challenges that affect patients nationwide.
- High Costs: Medical treatment in the U.S. can be costly, with bills ranging from thousands to hundreds of thousands of dollars, depending on the injury or illness. These high costs create financial burdens for many, especially those without comprehensive insurance.
- Hidden Coverage Gaps: Even with insurance, patients often encounter unexpected expenses. It’s crucial to confirm that hospitals and doctors are within your insurer’s network because using out-of-network providers can lead to significantly higher out-of-pocket costs, as insurers may only cover a portion of the fees.
- Limited Care in Rural Areas: Access to quality healthcare is uneven across the country. Rural communities frequently face shortages of medical providers and facilities, forcing patients to travel long distances for necessary care.
- Impact of State and Federal Policies: Healthcare availability and costs can vary widely depending on where you live and changes in laws. For instance, a federal law passed in 2022 capped the cost of insulin, providing relief to some patients, but such protections are not uniform nationwide.
Healthcare Access for Foreigners in the U.S.
Access to healthcare in the U.S. as a foreigner depends heavily on your immigration status, length of stay, and state.
Public Healthcare Access for Foreigners
Foreign visitors are not eligible for Medicare or Medicaid, and most “lawfully present immigrants” must wait five years before qualifying for these programs.
Additionally, the U.S. does not have reciprocal healthcare agreements with other countries, so any public or universal coverage from your home country does not apply while you are in the U.S.
Some states have more inclusive policies. For example, California allows all residents, regardless of immigration status, to enroll in Medi-Cal, the state’s Medicaid program.
Enrollment in public healthcare programs is not automatic. Applicants must apply, provide proof of citizenship or legal residency, and meet eligibility criteria, which vary by state.
Private Health Insurance Options for Expats
If you plan to live and work in the U.S. for six months or more, securing health coverage is essential. While federal law does not require expats to carry insurance, some states impose tax penalties if you don’t.
Here are your main insurance options as an expat:
- Employer-Sponsored Insurance: Most full-time workers receive health, dental, and vision insurance through their employer. Employers usually cover part of the cost, but employees still pay monthly premiums and deductibles. Coverage often includes spouses and children (up to age 26), though adding family members increases costs. Family members not covered by your plan – and who cannot legally work in the U.S. – may struggle to obtain insurance on their own.
- Marketplace Coverage: Many expats qualify to purchase insurance through the federal Health Insurance Marketplace at Healthcare.gov. These plans meet ACA standards and are available to lawfully present immigrants.
- Insurance Brokers: Another option is to work with a health insurance broker. Brokers – often at no cost to you – can help you compare plans and find coverage tailored to your needs. Some specialize in assisting expats and foreigners living in the U.S.
Find the Best International Medical Insurance
- Compare multiple quotes and coverage options
- Work with an insurance expert at no additional cost
- Find the best plan for your needs and budget
Even if you’re eligible for a U.S. health plan, be aware that coverage is typically limited to a specific state or region. A global medical plan may offer better protection if you plan to travel within the U.S. or spend time abroad while based there.
Read More: US Health Insurance for Non-Citizens
Healthcare for Visitors and Short-Term Travelers
Visitors cannot access public healthcare programs and must rely on emergency care in urgent situations.
U.S. hospital emergency rooms are required to treat patients regardless of ability to pay, but the costs can be very high and often require upfront deposits.
Because medical bills can quickly add up, purchasing travel medical insurance before your trip is strongly recommended.
If you plan to travel across different states or visit other countries while using the U.S. as a home base, choose a travel insurance plan with nationwide and international coverage, as most U.S.-based plans limit care to one region.
Find the Best International Travel Insurance
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- Travel Medical, Trip Cancellation & more options available
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If you are visiting the U.S. briefly, consider using a travel clinic specializing in care for international travelers. You can find them in most large U.S. cities or search using the Global Travel Clinic Directory from the International Society of Travel Medicine.
Read More: Travel Insurance for the U.S.
Accessing Emergency and Routine Care
Hospital emergency rooms are legally required to treat all patients, but emergency care is costly and must be paid for out of pocket by uninsured foreigners. Urgent care clinics are usually a more affordable alternative for non-life-threatening issues.
Many expats and residents have a primary care provider for preventive care and general health needs. Seeing specialists often requires referrals from your PCP, depending on your insurance plan. It’s important to confirm that your doctors and clinics accept your insurance to avoid unexpected costs.
Learn what to do in an emergency and how to access hospital treatment in our article on Hospitals in the United States.
General and Preventive Care
Most adults in the U.S. establish care with a PCP for routine health needs like screenings, immunizations, and chronic condition management. Parents typically register their children with a pediatrician for regular checkups and acute illnesses.
Dental and vision services are usually separate from standard health insurance. However, most plans allow you to visit dentists and optometrists without a referral – just make sure they’re in-network for your specific dental or vision coverage.
Pharmacies and Medication
Pharmacies are the go-to places for over-the-counter and prescription medications in the United States. They may be independent small businesses or part of major regional or national chains, such as Walgreens and CVS. Many clinics and large grocery stores also include an in-house pharmacy.
Over-the-counter medications are available at pharmacies, big-box stores, and online retailers. When shopping for common medications, check whether a lower-cost generic equivalent is available.
If you bring prescription or over-the-counter medications from your home country, keep them in their original labeled containers.
The U.S. Food and Drug Administration (FDA) recommends bringing no more than a 90-day supply. It’s also a good idea to carry a doctor’s note in English explaining why you need the medication.
Larger U.S. pharmacies often offer additional services like illness testing and treatment, health screenings, and vaccinations. Many have in-store clinics staffed by nurse practitioners or physician assistants and offer extended hours, including evenings and weekends.
Read More: Traveling Internationally with Prescription Medication
Recommended and Mandatory Vaccinations
In the U.S., vaccinations are available at pharmacies, doctors’ offices, and clinics. Most health plans cover standard vaccines.
Travelers to the United States do not need any mandatory vaccinations. However, many countries recommend updating routine immunizations before traveling, such as vaccines for measles, mumps, rubella (MMR), and COVID-19.
It’s wise to consult your doctor for personalized advice and to carry documentation supporting any medications or prescriptions you bring.
If you are immigrating to the U.S. and applying for permanent residency, certain vaccinations are required. For details on state-specific vaccine rules, refer to this list.
Read More: Vaccine Requirements for Traveling Abroad
How Much Does Healthcare Cost in the U.S.?
Healthcare in the U.S. is notoriously expensive, especially without insurance. Even basic treatments can be extremely costly. For example, visiting a doctor without insurance may cost 2–4 times more than if you were insured and in-network.
Prices vary by location, with higher costs in states like Connecticut, New York, or Hawaii.
Below are average price ranges (in USD) for common services:
- Pharmacy clinic visit: $60–$169
- Urgent care clinic visit: $60–$200
- Primary care visit: $100–$300
- Ambulance service: $400–$1,200
- Emergency room visit: $700–$3,400+
- Dental check-up: $50–$350
- Optometrist visit: $150–$250
Even with insurance, most people pay some portion of their medical bills. Typical out-of-pocket expenses include:
- Copayments: Fixed fees per visit or prescription
- Coinsurance: A percentage of the total cost after meeting your deductible
- Deductibles: The amount you must pay each year before insurance starts covering costs
- Prescription costs: Covered by some plans, but not all
Although out-of-pocket spending accounts for about 6% of total U.S. healthcare expenditures, it can be a significant burden, especially for those without insurance.
Healthcare Payment Systems and Subsidies
You usually pay copayments and prescription costs upfront. However, providers will bill your insurance to determine coverage and your remaining balance for more complex care, such as surgery or hospitalization.
Sometimes, you may need to pay first and seek reimbursement later. Providers of elective care, like dentists, opticians, or cosmetic surgeons, may offer payment plans or financing, often with interest.
If your insurer declines coverage, you’re responsible for the full cost. There is no fallback public healthcare system or financial assistance for foreign visitors. Because of this, most travelers and expats consider U.S. health insurance essential.
Many patients negotiate their medical bills or request payment plans for expensive services like surgeries or hospital stays. If you receive a bill, contact the provider’s billing department to ask for an itemized statement or to discuss payment options. Charges like lab fees or service fees are often negotiable.
Read More: How Much Does Healthcare Cost in the U.S.?
Registering for Healthcare and Insurance
Visitors do not need to register to receive emergency care, as hospitals and clinics must treat all patients. Long-term residents typically select healthcare providers through their insurance plans.
While primary care providers (PCPs) usually do not charge a formal registration fee, some may charge administrative fees during initial visits.
Most U.S. insurers require documentation such as:
- Identification: Passport, driver’s license, or possibly a birth certificate
- Proof of immigration status: Visa confirmation, immigration status certificates, or documents
- Social Security number: Tax forms or pay stub documentation may qualify
- Proof of residency: Rental or lease agreement, mortgage documents, or utility bills
- Proof of work and income: Employer and salary information, proof of income, or other employment status
If your insurance is employer-sponsored, your employer can often assist with paperwork and obtaining a Social Security number.
Processing new insurance applications can take up to 90 days, though enrolling during open enrollment periods can speed approval. Once registered, you will receive an insurance card and access to provider directories and plan resources.
“Land of the Free” Doesn’t Mean Free Healthcare
For expats and visitors to the United States, having quality coverage is the only way to access medical care without facing extremely high costs. Be sure to secure the right coverage before you travel or move.
Wherever you are in the U.S., know the location of the nearest urgent care clinic and the closest hospital in case of an emergency. It’s also important to confirm in advance that your insurance covers treatment at those facilities.
The U.S. is a vast and incredibly diverse country with so much to see and experience. Whether you’re visiting for a week or planning to stay for years, taking care of your health will help you make the most of your time there.
If you’re unsure which plan to choose, we can help. Talk or email with one of our licensed brokers for personalized advice. We work with trusted international insurers and offer free quotes to help you compare plans and find coverage that meets your needs in the U.S.
Watch More
Envisage International and International Student Insurance (ISI) have created a six-minute video explaining how the U.S. healthcare system works. It highlights common challenges and offers helpful tips for staying healthy while in the country.
While the video is designed for international students, the information is useful for anyone new to the U.S. It includes advice on preparing for your stay, examples of medical costs, how to find healthcare providers, and explanations of key insurance terms.
Read More
- How Does International Health Insurance Work?
- Differences Between Travel and Health Insurance
- Travel Insurance for Parents Visiting the USA
- The Best Healthcare in the World: Country Rankings
Author: Emily Cotlier is a senior editor at International Citizens Insurance. She has made the move from the U.S.A. to New Zealand. For International Insurance, she clarifies international visa and immigration requirements, shares travel resources, and advises on relocation challenges. She’s traveled through five continents and Oceania, and she still loves to travel both in Aotearoa New Zealand and around the world.